1845

We respectfully request that the 837i guide be amended to require that facilities report their CLIA identification number whenever they bill for lab services. Currently, the guide does not require providers to report the number nor does it identify an area where providers may report voluntarily. Payers need the CLIA information to ensure compliance with Medicare and Medicaid requirements and to ensure that providers are billing appropriately for their services.The presence of the CLIA number on the 837i, similar to its presence on the 837P, is the best way to ensure compliance with Medicare and Medicaid rules. The Medicare Learning Network and Medicare manuals state that “[f]or Medicare claims to be processed, the CLIA number must be reported on all claims for laboratory services.” In addition, under Medicaid, payers may pay providers for laboratory services under the Medicaid State plan “only if those services are furnished by a laboratory that has a CLIA certificate or is licensed by a State whose licensure program has been approved.” 42 CFR 493.1809.As experience has demonstrated, some facilities have inappropriately billed for services for which they have not had proper CLIA certification. Recently, UHC discovered that some small hospitals were billing for lab services performed by outside labs and not appropriately identifying the performing labs. If the facilities were required to report their CLIA number, payers would be able to determine that the hospitals’ CLIA certification did not cover the types of services for which they were billing.

Description

Add a REF segment to the Claim and Service loops to report the Clinical Laboratory Improvement Amendment (CLIA) Number like the reporting in the 837P.